Peninsula Gastroenterology Medical Group, Gastroenterologists logo for print
Peninsula Gastroenterology Medical Group, Gastroenterologists
Redwood City: 2900 Whipple Ave | Suite 245 |Redwood City, CA 94062 • Phone: 650-365-3700
Mountain View: 2495 Hospital Drive | Suite 600 | Mountain View, CA 94040 • Phone: 650-964-3636

Due to COVID-19 concerns, PGI is providing telemedicine services.
Telemedicine Telemedicine Help

Request
Appointment Patient
Portal
Patient
Survey
MENU

Online Referral Form

Below is PGI's secure online referral form for physicians.  You may use this form to securely refer a patient to our practice.

Referring Physician Information
Referring Physician Name:
Address:
Phone:
Fax:
 
Primary Care MD:
Phone:
Fax:
 
Patient Information
Patient Name:
DOB:
Address:
Primary Phone:
Cell Phone:
Work Phone:
Diagnosis/Clinical History:
Appointment Information
Consultation: Yes
Procedure: If so check the boxes of the procedure(s) needed.
 
Other Procedures Needed:
Comments, Requests:
     

Related Links

Atherton Endoscopy Center photo

Atherton Endoscopy Center


Map & Directions

While you are a patient at Atherton Endoscopy Center, our highly competent and professional staff will care for you. Everyone from the receptionist to the physician embraces our philosophy of patient-focused care. Above all, our staff is friendly and concerned for your comfort.